Correcting a code for pacemakers that could have cost seven figures each year

Recovered staff time with simpler, more robust reporting

Our Hospital implemented an integrated view of Allscripts EPSi modules Cost Manager, Product Line Analyst and Enterprise Management Dashboard. All the EHRs claim to increase revenue so having said that, we recovered $4.5 million over a two year period in underpayments using the EPSi’s Product Line Analysis Contract Modeling tool. Kind of speaks for itself and in the end this saved the day when at the negotiating table.

When we started this journey, our skepticism was high and asking can this product really deliver the much needed reporting. Our knowledge and experience came from a limited financial and patient data reporting abilities. Reimbursement rates lagged far behind the cost of care. We had always worked off of a fee-for-service and now facing the paradigm shift to value-based care models. The horizon has become this competitive landscape, and we needed a renewed focus in operational excellence to be the driving force of our future.

Contract negotiations with payers can be complex, and your foundation is all about facts in negotiations. While in a recent meeting with one of the payers they questioned our hospital admissions, stating they were high. They stated that we were just admitting everyone instead of using appropriated observation resources. With our reporting, we were able to check those assumptions almost immediately and present a report of it. It helped us see different scenarios, side by side for easy evaluation showing the incremental increases in observation stays for that payer over a year to year report. That was real data that could be used in the negotiations as well as being fair to the payers.

The Dashboards saved us valuable time that was wasted in all the hunting and research with reports. Now with the targeted reports it saves us time as well as helping leadership quickly identify areas that needed our attention and further investigations. We can now spend that wasted time in being proactive.

These modules helped us understand the total costs better, enabling us to recover the lost revenue in our negotiations with payers. This leverage enabled us to recover underpayments and helped us define the granular for what we charge, for services and don’t. The missing charges, incorrect codes, stop-loss corrections including bundling charges are the very details that have cost us so much in revenue. This program brought the ineffective to the light so that we could work with the efficiencies. This was a total win-win for our organization and highly recommended.

The five major areas we recovered costs in:

CDM bundles – Areas where payers were not reimbursing for services that were bundled incorrectly in the Charge Description Master.

• Stop-loss corrections – When we reached the contractual limit of what a payer will reimburse. When we reached stop-loss it was difficult to discover most errors. During the modeling process, we were able to identify these cases quickly

• Missing charges – In Charge Audits performed finding:

Services that were unbilled

Services not scheduled to be billed

• CPT – We were able to locate errant current procedural terminology codes, and re-assigned medical procedures to the correct group for reimbursements

• Claim settlement – We were able to mine for unpaid or denied claims and then renegotiated a settlement with the payer, avoiding significant financial losses

KLAS named this EHR as a Category Leader, Decision Support for the 8th consecutive year. I’d have to concur with this as this has given us such a return on investment.

One thought on “Allscripts | EPSi Review”

EMR’s are expensive. We do not feel that the rrcdeos will save us time or Staff. We multitask in order to be more efficient. We manage with a minimum amount of employees who are well trained and efficient. We are concerned with overhead expenses, of course. Insurance premiums for our Staff will go up 20% because of the new Healthcare reform laws that just went into effect. Rent is up, supplies are up, Malpractice insurance is up; reimbursements from CareFirst Blue Cross Blue Shield are dismal, somewhat better from other carriers.